George Yunupingu, a 72-year-old Indigenous Australian retired park ranger, presents to your regional GP clinic brought by his son after vomiting bright red blood twice this morning.
He reports two weeks of worsening epigastric pain, dark tarry stools for the past three days, and increasing lightheadedness on standing. He feels weak and nauseated.
Past medical history:
- Hypertension: irbesartan 150 mg daily, amlodipine 5 mg daily
- Type 2 diabetes: metformin 1 g twice daily, gliclazide MR 30 mg daily, HbA1c 7.8%
- Osteoarthritis (bilateral knees and hips): ibuprofen 400 mg three times daily for the past 6 weeks (no gastroprotection)
- Atrial fibrillation: apixaban 5 mg twice daily
- Alcohol use: 4–6 standard drinks daily
- Smoking: ex-smoker, 20 pack-years
Examination:
- Temperature: 36.9°C
- Heart rate: 112 bpm
- Blood pressure: 92/60 mmHg lying, 78/52 mmHg standing (orthostatic hypotension)
- General: pale and diaphoretic
- Abdomen: soft, epigastric tenderness; no peritonism
- Digital rectal examination: melaena
Point-of-care results:
- Haemoglobin: 78 g/L ↓ (reference 130–175 g/L)
- Blood glucose: 11.2 mmol/L
The nearest hospital is 45 minutes away by road ambulance.
Which of the following is the most appropriate immediate management?
Select 1 answer (1 correct choice).